Overcoming Low Self Esteem

In my private practice I just saw 36-year-old Boris. He had written his own profile for me: “Low self-esteem…I experience fear whenever I meet someone I find attractive…I always try to prove my worth to others…People sense it and use my weakness to their advantage. I often allow them some degree of abuse to avoid being alone.” This, coming from a person of obvious brilliance and a keen sense of humor.

Boris’s family were “refuseniks” in the USSR, Jews who wanted to leave for Israel. Although a violin prodigy, he was kicked out of a prestigious conservatory and placed in a working class school where he was taunted and beaten as a “refusenik-jewboy.” By practicing hard at home, he did get accepted to the Moscow Conservatory where he studied until finally coming to America via Israel.

He carried with him a strong fear of people, a strong sense of worthlessness and a strong need to get approval. Despite accomplishments of performing at Carnegie Hall, and academic successes, Boris saw himself as utterly unworthy of any social acceptance, especially from women. His hands shook and he sweated whenever he was in the company of a woman he was attracted to. Being tongue-tied, and deferential, they treated him with contempt and he dreaded going out. He saw himself devoid of social value.

The concept of self-esteem, in both my opinion and the opinion of recent research, is overrated. Boris constantly evaluated himself and found himself deficient. When I pointed out that we are all people of worth, and that we should evaluate our actions, not our self-worth, he vigorously objected. After hearing him self-indict, I laughed and said, “OK, we agree that you are the most worthless piece of sh-t on the planet. How does that help you?” He laughed and said he felt relieved that we agreed on his worth. Now he didn’t have to convince me. Now we had to work on this “worthless” person getting somewhere.

After some discussion, Boris described his social life. Being convinced of his worthlessness, he went into business. Feeling that woman are attracted to wealth—which is true—he now has a boat and a successful business and offers them dinners at south shore restaurants. However, being tongue-tied, he gets rejected regularly.

I asked Boris if my early dating experiences related to him. I was so in need of approval that I kept reading the signs. “Does she laugh at my jokes? Does she look bored? How can I get her interested in me?” Because I focused on her reactions and not any topic, I could not be myself and I was tongue-tied. Boris agreed that was him. He was more a raft, drifting with the winds and currents than a powerboat he directed.

Change requires practice and I encouraged Boris to date. He interpreted rejection as confirming his lack of worth. My view is that many restaurant menus have 50 items and we reject 49 of them. Yet, the items wouldn’t be there if no one wanted them. Some women will not be to his taste and he won’t be for all markets either. That does not connote worth. In the past, Boris has gone over a litany of faults before and after dating. He claims that these faults confirm his negative self-esteem. My claim is that we are all imperfect human beings but that we are all people of worth. It is early in therapy to see change, but I think that Boris is grandiose to think, “he is the most worthless…”

That same evening of the first session I received a text message: “…your therapy worked… I managed to get laid tonight, a miracle. Thanks!”

Illustration by Tom LaMothe